Many people wonder how estrogen, which is a female reproductive hormone, can have anything to do with bone health.

We hear you! And we have got an answer as well.

This article discovers the role and effects of estrogen on osteoporosis.

What is osteoporosis?

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Osteoporosis is a medical condition that leads to fragile bones. This condition affects women 4 times as commonly as men. One must wonder why nature is unfair and why this disease seems to affect women more often than men! The reasons have to deal with the reproductive hormones of a woman - mainly estrogen. 

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What is Estrogen?

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Estrogen is commonly known as the “female hormone”. It is secreted in your body by your ovaries and has not only reproductive but a myriad of other functions to perform - one being strengthening bone.

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Relation of estrogen to bones

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Human bones have 2 types of cells - bone makers (Osteoblasts) and bone breakers (Osteoclasts). These two cells are in a constant tug of war — with osteoblasts forming new bone and with osteoclasts resorbing/breaking down bone. This leads to the constant “remodeling” of bone. Estrogen acts on these osteoblasts, thus helping new bone formation and reduces the activity of the osteoclasts. Apart from this, Estrogen also helps your intestines to absorb calcium from food. Calcium is the primary mineral in bones and helps to keep bones strong. Remember your mom insisting that you HAVE to drink at least a glass of milk?! The milk (along with other dairy products and green leafy vegetables) served the role of a calcium booster. 

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Bone loss

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A woman’s (as also a man’s) bone mass peaks by the time they reach thirty. The osteoclastic (bone-breaking) activity gradually takes over the osteoblastic (bone making) around this age. This point is the onset of the loss of bone mass.

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This loss of bone mass continues at a steady pace till the woman reaches menopause. After menopause when the estrogen levels decline — there is an accelerated loss of bone mass. 

This happens because women do not have enough of estrogen after menopause. With the protective effect of estrogen lost, women start losing more bone and thus end up having weaker bones.

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Diagnosis of osteoporosis

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Measuring bone mass

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 Bone mass, or bone density can be measured by a special type of a CT scan and a procedure called the Dual Energy X ray Absorptiometry- the DXA or the DEXA scan.  This is a painless procedure that is carried out in ten to twenty minutes. The machine measures the thickness of the bone by recording how many X-rays pass through a given point. The comparative differences between the two beams help your doctors understand your bone density. Then the results are compared with the bone density of a healthy young adult (T Score) or an age matched young adult (Z Score). 

The lower the score, the lower is your bone density.

 If you have a score between -1 to 1(SD) then your bone mass is adequate. A score of less than 1 but more than -2.5, is known as low bone mass, or osteopenia. And a score of less than -2.5 implies that you do have some form of this degenerative bone disease- osteoporosis. 

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Available treatments to prevent osteoporosis 

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Some loss of bone mass after menopause is obvious. But it won’t affect you critically if you have strong bones to start with.

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Prevention is always better than cure. The most efficient way to have a good bone mass is through a healthy lifestyle. Resistance training/weight training exercises and consuming calcium-rich food can help you to have stronger bones. Along with calcium, your body also requires Vitamin D — which helps the absorption and utilization of calcium.

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The treatment that your doctor recommends will depend on several factors including what was discovered through an assessment of your situation. This can include estrogen therapy, bisphosphonates or alendronate injections, a calcitonin nasal spray, and other forms of treatments used to slow down bone loss and reduce further risk of fracture down the line. 

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Hormone therapy (HT) is the treatment of choice for osteoporosis in carefully selected women within less than 10 years of menopausal age. It's important to note that bisphosphonates help in preventing osteoporosis in older women who are 60 years or older. Selective estrogen receptor modulators (SERMs) like raloxifene can be used as an alternative by women who are unable to use bisphosphonates or HT.

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Disclaimer: The treatment discussed in this article is not meant to be a substitute for professional medical advice. Always consult with your doctor before starting any treatment. Please consult a doctor for the best treatment options for you personally.

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Conclusion

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Osteoporosis: A major debilitating and chronic disease that causes the bones to become brittle and break easily. Women are prone to osteoporosis more than men because of the substantial decline in estrogen levels in the body. 

Enormous research has demonstrated that estrogen deficiency plays a significant role in the development of osteoporosis. Estrogen and menopause themselves are linked. However, taking an educated step at the right time can help you to prevent osteoporosis or if needed get the right treatment. 

Make the required changes in your lifestyle and consult a doctor at Elda Health to assess your bone health today. 


Reviewed by Dr. Ameya Kulkarni